Sodium-glucose cotransporter 2 inhibitors reduce new-onset heart failure and death after myocardial infarction with a preserved ejection fraction following coronary intervention.

Abstract

Purpose: To evaluate whether SGLT2is (sodium-glucose cotransporter-2 inhibitors prevent new-onset heart failure (HF) in patients with preserved left ventricular ejection fraction (LVEF) following percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI).

Methods: This retrospective cohort study enrolled AMI-PCI patients with LVEF ≥ 50% and no prior HF. Based on discharge medication, patients were assigned to a SGLT2i group (empagliflozin or dapagliflozin 10 mg once daily) or a non-SGLT2i group. After 1:1 propensity score matching (PSM), 115 matched pairs were identified. Fasting glucose, lipid profiles, estimated glomerular filtration rate (eGFR), N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin I (hs-cTnI), and echocardiographic values were assessed within 72 hours post-PCI. The primary outcome was the occurrence of new-onset HF events; secondary outcomes included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Follow-up period was at least 18 months.

Results: SGLT2i significantly reduced new-onset HF events (6.09% vs. 15.65%, P=0.020), all-cause mortality (3.48% vs. 10.43%, P=0.038), cardiovascular mortality (1.74% vs. 9.57%, P=0.010), and MACE (7.83% vs. 18.26%, P=0.019). Multivariable Cox regression confirmed SGLT2i use as an independent protective factor (HR, 0.583; 95% CI, 0.371-0.916; P=0.017).

Conclusion: Among patients with AMI undergoing PCI and preserved LVEF, SGLT2 inhibitor use was associated with a significant reduction in new-onset HF events and improved survival outcome.